Posted on August 25, 2008

Markos asked for more; I answer: Obama on Single Payer


by DrSteveB
Thu Aug 21, 2008

Yesterday our great orange leader Markos asked to know more about Obama’s being quoted in the Wall Street Journal as supporting Single Payer national health coverage. Here’s what Obama actually said at the New Mexico event:

“If I were designing a system from scratch, I would probably go ahead with a single-payer system,” Obama told some 1,800 people at a town-hall style meeting on the economy.


But Obama repeated that he rejects an immediate shift to a single-payer system. “Given that a lot of people work for insurance companies, a lot of people work for HMOs. You’ve got a whole system of institutions that have been set up,” he said at a roundtable discussion with women Monday morning after a voter asked, “Why not single payer?”

“People don’t have time to wait,” Obama said. “They need relief now. So my attitude is let’s build up the system we got, let’s make it more efficient, we may be over time—as we make the system more efficient and everybody’s covered—decide that there are other ways for us to provide care more effectively.”

Actually there is nothing new here. It’s the same formulation Obama has said/used in recent years, and only a slight shading of a change from where he was earlier. But since inquiring (or is that enquiring minds want to know, here is the rest of the story:

First, it should be noted that in addition to whatever policy analysis he has done, Obama actually has something of a personal connection to knowing about single payer since (I am not breaking any confidentiality here, since it is public knowledge) the physician group that he has been going to for years for his own personal medical care includes one the most famous physician single payer (and all around progressive political) advocates, Dr. Quentin Young. Given the political activism of that physician group and the young Mr. Obama’s intests in politics and policy, one can assume it has been discussed during check-ups! Obama attended Quentin’s 80th birthday back in 2003.

Now here is a video of Obama in 2003 speaking to the Illinois State AFL-CIO on June 30, 2003, supporting Single Payer as what he would like to see:

Transcript from Obama in 2003:

“I happen to be a proponent of a single payer universal health care program.” (applause) “I see no reason why the United States of America, the wealthiest country in the history of the world, spending 14 percent of its Gross National Product on health care cannot provide basic health insurance to everybody. And that’s what Jim is talking about when he says everybody in, nobody out. A single payer health care plan, a universal health care plan. And that’s what I’d like to see. But as all of you know, we may not get there immediately. Because first we have to take back the White House, we have to take back the Senate, and we have to take back the House.” - Obama speaking to the Illinois AFL-CIO, June 30, 2003.

But here is how it gets, perhaps, slightly, revised, by now national candidate Obama in 2007, at our very own YKos meeting in Chicago, to saying the same thing as he is quoted in the Wall Street Journal as saying:

It is even on the Obama campaign fact check page, that his language (at least since going national after 2003) has been consistent:

If Obama Were Starting From Scratch, He Would Support A Single Payer System

So perhaps it is rhetorically just a smidge weaker in 2007-to-Present, compared to what he said in 2003; but really it is substantively the same. He would prefer single payer in principle, but current actual fight is limited to what he sees as what is feasible. And after that, who knows…

This is a common formulation/excuse… to acknowledge that single payer is better, but that it is politically impractical, and therefore to fight for some compromise alternative that one knows is not as good.

It is actually somewhat better then the approach/response the Clinton’s have always given which is complete and total a priori dismissal of Single Payer.

But it is still a little bit sad — to recognize what most in the health economic and health policy field acknowledge, and what independent analysts such as the GAO, the CBO and the Lewin Group have all determined that Single Payer is the only way to get to Universal coverage, Comprehensive coverage, Individual affordability, and System-wide cost control — and still shy away from actually fighting for it.

But as an advocote and wonk, I am not dependent on corporate support, nor do have some psychological investment in cheering for the (in the short run only) winning side… I choose to support the actual best plan.

How about you?